Driving COVID-19 vaccine uptake

The Delta variant of COVID-19 is threatening to stall the re-opening of economies and a return to life as we knew it before COVID-19. At the same time, the evidence for the safety of COVID-19 vaccines, and for the substantial effectiveness of vaccinations in reducing COVID-19 related deaths and severe disease is now beyond debate. For these reasons, leaders in government, business and communities must now redouble their efforts to accelerate both the roll-out and the uptake of COVID-19 vaccines, failing which countries will continue to experience multiple waves of COVID-19 infections and consequent increases in hospitalization and mortality.

Vaccine hesitancy has emerged as a major stumbling block to achieving the required high vaccination rates, and this generated heated debates on the relative merits of positive or negative incentives and vaccine mandates to drive up vaccination rates.

Access and information

Although mandates and vaccine passports attract public attention, many experts suggest that the most effective way to increase uptake is simply to make vaccines as accessible as possible for those who are short of time and motivation but are not actively opposed to get their jabs. Research from the UK Office for National Statistics showed vaccination rates were markedly lower among communities that are deprived or do not have English as a first language. In response, the government implemented a series of targeted initiatives, including culturally sensitive messaging and use of trusted local leaders as community champions to combat misinformation (The FT 2021). In South Africa, it is very clear that many communities, particularly in remote rural areas, but also in more densely populated urban areas, do not have easy access to vaccination centres, and that transport and other obstacles stand in the way of increasing vaccine uptake. There are therefore clear and relatively simple interventions to address these significant causes of low vaccine uptake – governments and other stakeholders must work hard to ensure that vaccines are easily accessible and widely available, and they must invest substantially in providing appropriate, culturally sensitive information to persuade citizens of the vital importance of being vaccinated, at the same time reassuring them of the safety of the vaccines.

According to the WHO’s “Our World in data”, Portugal has one of the world’s highest vaccination rates, with 83% of its population already fully vaccinated. Some health experts reported that this success is attributable to constructive co- operation between health professionals, the military, and local officials. A government mandated taskforce co-ordinated a network of 300 vaccination centres run by 5,000 doctors, nurses and volunteers. According to the Health Minister, these efforts have been vital to the success of the roll out. This increase in access to vaccination sites has also meant that Portugal has had no need for vaccine mandates.

Carrots and sticks

Aside from ensuring access and providing information, many organisations have experimented with positive and negative financial incentives to encourage vaccine uptake. A UCLA COVID- 19 Health and Politics collaboration has interviewed over 75,000 people about their pandemic experience and attitudes, and has measured these along political and economic dimensions. The collaboration, which is still ongoing, reported that roughly a third of the unvaccinated population said a cash payment would make them more likely to get a shot. This suggests that some corporates might be on the right track. Vanguard, a financial- asset management company, for example, is offering its 16,500 employees a?$1000 bonus to get vaccinated before October 1st ?2021.?

Some health and life insurers have weighed in to boost vaccination numbers using financial incentives as well. In South Africa, Discovery Life is offering a first- of- its- kind COVID vaccine underwriting determinant for the South African life insurance market. Vaccination status has now become an additional consideration in determining Life Insurance premiums for new clients. Members who are vaccinated are able to obtain lower premiums, and are also offered increased additional behaviour linked premium refunds.

During the first year of the pandemic, health insurers and self insured employers typically shielded policyholders and employees if they got COVID-19 and required treatment. Since the vaccine has become available, those policies have begun to change. United Healthcare in the U.S is now applying co- payments and deductibles to claims for COVID- 19 treatment. Some payers have taken it a step further by increasing premiums for the unvaccinated. Delta Air Lines recently announced it would charge unvaccinated employees an extra $200 a month for their health coverage.?Following this, Delta’s Chief Health Officer reported that 20% of its unvaccinated employee group registered for vaccination since the announcement in August. United Airlines set out its COVID policy for its 67000 staff in August, requiring them to upload proof of vaccination, or the first of two jabs, by the deadline of the 4th of October. Employees who refuse to get vaccinated and have not applied for an exemption on religious or medical grounds now face losing their jobs. Scott Kirby, CEO at United Airlines, recently announced that 7 weeks after rolling out one of the most comprehensive employee vaccination policies, 99% of their U.S.- based employees who did not submit for an accommodation chose to get vaccinated.?

Mandates and vaccine passports

Notwithstanding these many efforts to encourage and incentivize COVID-19 vaccination, uptake remains stubbornly low in some countries and regions, and in response, several countries and employers are turning to either vaccine mandates or vaccine passports to drive up vaccination rates. There is ample justification, in law and in political theory, for mandating actions that prevent harm to others. This is precisely the role of countless laws we all accept as second nature –speed limits and drunk driving laws are two obvious examples. This does beg the question of why so many people seem to naturally accept these laws, which are clearly curbs on their freedoms, yet resist the notion of a vaccine mandate or the requirement to show vaccination status for entry to certain venues, which is based on precisely the same rationale – that curbing individual freedoms can be justified if such curbs clearly prevent harm to others.

According to research by the FT, strong government actions to encourage vaccination, such as enforcing the use of vaccine passports have driven a surge in vaccination rates. In Italy, vaccination bookings increased by up to 200% after the government declared it would expand its health pass for entry to restaurants and other public settings. ?In France, the government’s measures requiring vaccine certification to enter many venues have materially strengthened a vaccine campaign that was being threatened by vaccine hesitancy. Although France is known for having many vaccine sceptics amongst its citizens, daily vaccine bookings soared from 150, 000 in June to over 400, 000 in mid- July, following the introduction of vaccine certificate requirements for venue entry.

Employers across the globe, in both the public and private sectors, are considering similar measures. Dr Anthony Fauci told Bloomberg recently “I would encourage private enterprises to seriously consider the idea of mandating vaccination”. In the United States, companies such as Walt Disney, Uber, Walmart, Google, Facebook, and United Airlines have begun a campaign compelling their employees to be vaccinated. In France, 2.7m French health and social care workers have been ordered to get the COVID vaccine or risk suspension without pay, and Italy recently announced that all workers will need to show proof of vaccination or else they will be suspended and face fines from October 15th.?Closer to home, the Discovery Group recently announced that vaccination will be mandatory for all employees by 1st of January 2022, leading the path for other employers in the country to follow. This announcement was promptly followed by a similar one from Sanlam, one of South Africa’s largest insurers, and we expect that many other South African employers will soon follow with similar measures.

Interestingly, polling by YouGov has shown a surge in willingness to be vaccinated around the world over the past nine months. There are likely many causes for this, including increasing evidence of the safety of the COVID-19 vaccines, stronger and stronger evidence that hospitalisations and deaths in the most recent waves are almost entirely occurring in the unvaccinated, and also the growing trend towards either vaccine mandates or incentives. This provides further support for mandates or certification measures as a means of ensuring adequate uptake of COVID-19 vaccination.

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Individuals who refuse to get vaccinated increase the risks to themselves and those of others of being harmed by a potentially deadly or disabling disease. The persistence of large numbers of unvaccinated individuals will also raise the risk of successive waves of COVID-19, thus perpetuating the already enormous social and economic costs of the pandemic. Governments, employers, insurers and many other stakeholders are uniquely positioned to play a pivotal role in COVID vaccine adoption. These institutions must now urgently leverage their positions of influence, and their resources to help citizens of every country to overcome vaccine hesitancy by taking measures to improve access, to incentivize uptake, and where uptake remains low, to implement firm mandates or vaccine passport requirements. Failure to take these actions will mean that our world will continue to live with the severe impacts of this pandemic for many years to come.

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